Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Littmann’s EKG Course: T Waves

  • 1-3mm upsloping ST depressions in V1-V6 with tall, symmetric T-waves is highly concerning for hyperacute proximal LAD STEMI.

    New Wellens LAD

    This EKG was taken prior to cath of a patient with a 100% proximal LAD lesion. Note the upsloping ST segments.

    • N Engl J Med 2008;359:2071-3       Heart 2009;95:1701-6
  • The T-waves in hyperkalemia are often simply narrow-based rather than tall.  Because of this, the computer software often "double counts" the heart rate.


    This patient has a K+ of 7.2. Note that the computer "double-counts" the heart rate.


Chest Pain Master Class

  • Cocaine Chest Pain - patients with cocaine chest pain typically do well. Patients with positive urine cocaine tests are NOT stressed at our institution. They can be safely ruled out with serial troponins.
  • Erlanger protocol doesn't just mean 2 EKGs, 2 sets of enzymes, 2 hours 'n go.  They require a true reevaluation prior to discharge, EKG comparison and followup the next day - and must be low-risk.
  • In the ED evaluation of the chest pain patient, classic risk factors like DM, HTN, and tobacco use are "nuisance" variables and do not affect your pretest probability. Clinician gestalt is overwhelmingly correct.
  • A Coronary Calcium CT score of zero is good for approximately 1 year (and possibly longer in those aged 35-45).